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Ocean & Marine Cargo Online Application

Outlined below is the basic information we will need to obtain a Marine quote on your behalf.

Type of Coverage:
Name Of Applicant:
Address:
Cargo To Be Insured: (New or Used, Describe Fully)
Description Of Packing:

Container Shipments:

Indicate %'age of your goods shipped in containers %
Is cargo shipped in a "door to door" or consolidated container?
Maximum value in container(s): $
Average value in container(s): $

Basis of Valuation - valued at amount of invoice cost. Insurance and any freight at risk plus: %

Terms of Sale: (ie. FOB, CIF, etc.):
Exports
Imports
Inland

Average Value of Consigment By:

Sea $
Air $
Inland $

Maximum Value Shipped:

$ by any one vessel or one usual connecting conveyance
$ by any one aircraft and usual connecting conveyance
$ per shipping package by parcel post
$ by any one carrier on North American Inland Shipments

Estimated Amount of Yearly Shipments:

By Sea $
By Air $
Within Canada/USA $

Duty Insurance Desired On Imports?
Do You Declare The Value Of Shipments To Carriers?
Name of Steamship Lines and/or Airlines Pricipally Used:
Countries - To or From Which Shipments are Principally Made: (% by country)

Has any Company Ever Cancelled Or Refused Insurance Of This Description?

Premiums and Loss Experience During The Previous Five (5) years:

Year Premiums Paid Losses Incurred

Comments:


Contact Information

Contact Name:
Phone:
Fax:
Email Address:
 

 

 

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CONTACT INFO

Hubbard Insurance Group

135 Matheson Blvd. W., Suite 202,

Mississauga, ON L5R 3L1

Tel: (905) 712-4668

Fax: (905) 712 3586

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